With chronic illnesses such as diabetes and cardiovascular disease on the rise across the nation (a RAND study estimates more than 170 million Americans could be living with one or more chronic conditions by 2030), and the aftermath of COVID-19 still adding up to deteriorated health for many, it seems reasonable, if not critical at this time, for optimal health and overall wellness to be prioritized, especially in uniquely vulnerable communities.
In these communities, among the most vulnerable organs impacted by today’s formidable roster of prevalent illnesses are the kidneys.
According to the American Kidney Fund, 37 million Americans have kidney disease, and 808,000 Americans are living with kidney failure. The disease is growing rapidly and affects more than 1 in 7 American adults, with people of color at greater risk for kidney failure. With the recent adjustment of a long misguided, race-based kidney function calculation, more Black people will present with kidney disease than ever before.
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From his front-line vantage point at the PIH Health Good Samaritan Hospital in downtown Los Angeles, nephrologist and internist Dr. Vincent Anthony is ringing the bell about health challenges for Black and brown patients, in particular, and healthy kidneys, he says, are key. He implores the community to heed the toll and open the door—to a wellness mindset.
Dr. Anthony sat down with the Los Angeles Sentinel to discuss the significance and the impact of kidney disease, and how he is approaching it as a physician.
LAS: Why is kidney disease so important to this community?
DVA: Kidney disease is very important to the Black community. Having kidney disease actually increases the mortality of other diseases that you may have. Everybody knows about diabetes. Everybody knows about high blood pressure. Everybody knows about heart disease, stroke, all of those diseases that cause a lot of illness, and these actually are magnified when someone has kidney disease, but the problem is…a lot of folks don’t even know that they have kidney disease. They tend to find out later.
35% of people on dialysis are Black, and 30% of dialysis patients are Latino or Hispanic. A full 65% of people, Black or brown, are hit with this. So that’s really who I’m trying to target in my office practice.
A lot of Black people have a genetic predisposition to kidney disease. APO L1 is the gene. APO L1 puts us at a genetic predisposition to get kidney disease. 13% of African Americans have the high, high-risk gene, 39% more have a hybrid allele, which renders you at increased risk but less than the high-risk people. If you add those together, almost 45-50% are predisposed to kidney disease and rapid progression of that kidney disease.
LAS: What makes the kidneys so delicate, and what makes them so important?
DVA: One of the functions of the kidney is it cleans the blood, so that toxins are removed from the blood, the majority of toxins. The liver does some, and the kidney does some, primarily. And the gut does some. If you don’t eliminate those toxins, it affects every cell in your body. It changes the metabolism.
It’s about understanding kidney disease from all perspectives.
If you have arthritis, understand that your kidney can affect arthritis. If you have chronic obstructive pulmonary disease, understand how the kidneys actually help modulate that disease. Like I said, heart disease, stroke, diabetes, high blood pressure, immune dysfunction like HIV [are all affected by and affect the kidneys]. Drug abuse and HIV are on the rise in our community, and people don’t understand that kidney disease is related directly to HIV. HIV causes kidney disease in a lot of us, and so does drug abuse, particularly cocaine and amphetamine. We’ve had some deaths from this new fentanyl epidemic that comes from the kidneys getting acutely affected.
LAS: You have such a strong sense of mission. This practice feels personal for you. You must feel such a tremendous sense of responsibility, caring as you do and realizing so many people don’t have resources.
DVA: There is a big responsibility. I love Black history and politics. My father was the first Black man to vote in North Mississippi after voting rights were gained in the 1960s, and my grandfather was one of the first seven members of the NAACP in Memphis, North Mississippi, so he created that chapter. Having grown up in Mississippi, you see stark differences in white society versus Black society.
We were not fully integrated in Mississippi until 1985 or 1986.
The reason it’s so passionate to me is that our people have more ill health than other populations. That directly translates into an economic disadvantage, and we’re already disadvantaged from a long time ago. But if you aren’t healthy, you can’t build businesses. If you aren’t healthy, you can’t think of new ideas. So, the health comes along with an economic empowerment that we must have side by side.
I went into this to take care of my folks. I’m the only doctor in a huge family, so it’s very meaningful to me to do this.
[African Americans] are the most resilient people on the planet, bar none, based on our ancestors and what they’ve done. It’s just a privilege to be able to continue that work that they started years and years and years ago
LAS: When did you become inspired to focus on Nephrology?
DVA: Around the time that I was an intern, I was in internal medicine, following that path of focusing on internal medicine first before going into surgery so that I could become this world-class surgeon. And that’s when my people got sick with kidney disease. It was a painful time. And I said this is what I’m going to do. I really knew I could do nephrology even back when I was still focused on being a surgeon because surgeons really have to know fluids and electrolytes. Let me tell you what inspired me most. After I decided as an intern that I was going to be a nephrologist, I volunteered to do some different things. There was nothing more beautiful than seeing somebody on dialysis who went to get a transplant, and while they’re on the table, urine starts flowing in the bag. There was nothing more satisfying to me than seeing that and saying, whoa, we know this patient now is not going to be tethered to a machine. They’re going to be able to live life. For me, I think that was an eye-opening moment.
LAS: What are three things, in terms of lifestyle, that people can do to work preventatively against the onset of CKD, that is, chronic kidney disease?
DVA: A lot of disease occurs because of inflammatory mediators from these different diseases, so one of the things I always encourage my patients to do is increase their intake of antioxidants— blueberries, blackberries, whatever foods have increased antioxidants in them. I also suggest that people look at a chemical called L-arginine. L-arginine is one of those things that actually slows down the progress of scarring in the kidney, and at the heart level. It is the only compound that has been shown to take cholesterol plaque off of the blood vessel. And blood vessels leading to the kidney also get plaque buildup, so L-arginine works on that, and it works on the antioxidants.
Number two, keep yourself hydrated. Too often, we’re not drinking enough fluids now. When I say hydrated, I don’t mean to drink a lot of water, because if you drink straight water, it’s going to dilute some of your electrolytes, and you’ll just urinate the water out. Because, if the kidney is working properly, that’s what it should do. Balance the water. What you want to do is drink water with minerals. You do want to drink water, pure water, but you also want to have water with minerals in it, because that creates a tonicity of the fluid that matches the tonicity of the blood, so it tends to stay in the system. It’s simple chemistry and physics.
Hydration, true hydration is very important. Not just drinking water, but your herbal teas, your Pedialyte-type fluids, although some of that stuff has too much sugar in it.
Vitamin water is another good one that doesn’t have as much sugar.
The third thing is, I want people to understand that the kidney is a ball of specialized blood vessels. So, anything that you do that benefits your heart and cardiovascular system necessarily benefits your kidney. What I mean by that is exercise, exercise, exercise. Even if it’s just walking. Staying away from smoking. It hurts the kidney, not directly, but through the blood vessel problems that it brings. Anything you do that damages the cardiovascular system is damaging the kidney because the kidney is specialized blood vessels.
LAS: How did COVID-19 affect kidney function? Did we see a decrease in GFR (glomerular filtration rate) in people who got COVID?
DVA:People got kidney disease who had COVID. Let’s say they had acute renal failure, acute kidney failure. They were put on dialysis because of their acute kidney failure. There was a study that showed 1,000 people had dialysis because of COVID. 500 of them came out of the hospital still needing dialysis. Of those others, I think 60% of them had chronic kidney disease thereafter. So that’s just one example. That was a small study of 1,000 people. It was kind of observational. So it wasn’t really a highly powered study to truly show causality. I’ve got to stress that as an epidemiologist. It was an observational study, but it points us in a direction that says that yes, COVID actually caused a lot of CKD.
Anything inflammatory, whether it be COVID, HIV, drug use, hypertension, diabetes, any inflammatory condition, it can turn that APO L1 gene on and cause the kidney failure. That is
one of the reasons COVID affected African Americans four times more than it affected anybody else.
LAS: Looking at it on a large scale, are individuals with CKD getting the care that they need?
DVA: President Obama’s administration said that dialysis patients should be able to get on a Medicare Advantage plan. There’s something called the 21st Century Cures Act that was passed in 2006 and was supposed to start in 2021.
What used to happen is that, if someone had a Medicare Advantage plan and they wound up on dialysis, the Medicare Advantage plan would kick them out of the plan and onto Medicare so that Medicare could take care of all the dialysis services. Over time, that hastened the development of an increased cost to the CMS for dialysis patients. So less than 1% of the Medicare rolls actually caused 7% of the spend for the entire budget of CMS (Centers for Medicaid & Medicare Services).
With the 21st Century Cures Act, patients can’t be kicked off the Medicare Advantage Plan to dialysis. Also, dialysis patients who are already on dialysis now can directly enroll with Medicare Advantage. Now why is that important? It’s important because Medicare Advantage plans typically offer expanded services to their patient population. It’s important for the dialysis patient because, for instance, dental coverage is not offered in traditional Medicare, and so with Medicare Advantage plans, dental coverage is offered. It’s important for the dialysis patient because, anytime you or I brush our teeth, bacteria gets in the bloodstream, so if someone has a dialysis abscess, there’s a higher likelihood just by having poor dentition that you get your abscess infected, which means that it may have to come out, which means that you may miss dialysis. Sometimes it means you may go into septic shock just from brushing your teeth, or just from having poor dentition. So what I’ve developed is a company that partners with aligned health plans to make sure that we have a doctors’ group that takes care of these people and takes care of people in a culturally relevant way.
Learn about Dr. Vincent Anthony’s new physicians group in Part 2 of Kidney Conversations with Dr. Vincent Anthony next week.
Contact Dr. Anthony’s office for appointment inquiries at (213) 484-4929.
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